Dental Insurance Fee Caps, Self-Funded Plans & How CDT Codes Are Made | Dr. Greg Grobmyer
November 17, 2022
Do you have to honor an insurance write-off on a service the plan doesn't cover? Dr. Greg Grobmyer of Practice Booster explains why your state's fee-capping law may not apply to half your patients, how to ask a payer about upgrades, why the HITECH waiver can backfire, and how CDT codes actually get made. In this episode: - Anyone can propose a new CDT code: how the Code Maintenance Committee works - Code modifiers, and whether dental coding is turning into medical coding - Will insurers start paying differently by material? - Stationary intraoral tomosynthesis, and coding 3D-printed crowns as ceramic - Self-funded (ERISA) vs fully insured plans, and why it matters for fee caps - Asking the payer about upgrades, and documenting it - Why the HITECH waiver is risky, and a safer workaround for big cases Recorded in late 2022, so check the current CDT manual for today's codes. Plus 2022 dental news: a topical treatment for bisphosphonate jaw necrosis from UCLA, a planned dental school in Arkansas, dental care for pregnant patients, and the ADA's new wellness ambassadors. Dr. Greg Grobmyer graduated from the University of Tennessee Health Science Center and practiced in Tennessee for over a decade until cancer treatment ended his clinical career. He edits Practice Booster's Insurance Solutions newsletter and the Coding with Confidence books with Dr. Charles Blair, and speaks nationally on dental coding and insurance. 🙌 Special shout out to Q-Optics for making this episode possible! Chapters: 0:00 Intro 0:44 News: a topical treatment for bisphosphonate jaw necrosis 3:22 News: Arkansas plans a dental school 4:30 News: dental care for pregnant patients 6:16 News: the ADA's wellness ambassadors 8:15 Introducing Dr. Greg Grobmyer 10:44 From Arkansas to dental coding 12:25 Colon cancer at 36, and a career pivot 15:44 How CDT codes get made 16:52 Anyone can propose a new code 20:37 Code modifiers: is dental coding becoming medical? 25:03 Will insurers pay differently by material? 28:29 Who's pushing these changes? 30:15 2023 code changes 31:59 New membrane codes 33:00 Stationary intraoral tomosynthesis 35:03 3D-printed crowns can be coded as ceramic 37:15 The case for and against printed crowns 42:15 Do you have to honor fee caps on non-covered services? 43:42 Self-funded vs fully insured plans 46:44 What counts as a non-covered service? 47:40 First, ask the payer about upgrades 50:44 When the fee won't cover a big case 51:19 The HITECH waiver, and why it's risky 54:55 A safer workaround 55:41 You can't just choose not to bill insurance 57:17 Closing 🎧 Listen to the podcast: Apple Podcasts: https://podcasts.apple.com/us/podcast/dentists-in-the-know/id1543254763 Spotify: https://open.spotify.com/show/2Elfj6LX0hCUyp0AgdTsij 📺 Make sure you subscribe to catch new episodes live every Wednesday at 8pm ET! https://www.youtube.com/@dentistsintheknow 🌟 Stay up to date on all the latest dental trends when you follow the DINKs: https://fanflet.com/dinks/social-2
